This is an application to identify and intensively study panic attacks and panic disorder in children and adolescents who present to pediatric emergency rooms, pediatric clinical services and psychiatric services. Isolated panic attacks are prevalent in adults (10%), and although the lifetime prevalence of panic disorder is less (1.6%), it is a disabling condition with high morbidity. Until recently, panic disorder was considered a disorder of adulthood that did not occur in children or adolescents. Our preliminary work, recent isolated clinical reports, epidemiological studies and retrospective reports of adult patients reporting age of first panic episode strongly indicate that panic disorder does occur in children. Children and their parents, like some adults, may interpret their symptoms as physical in nature and many will visit pediatricians and emergency rooms to rule out medical illness. Pilot data will be collected within the confines of the limited time period and budget of a small grant to lay the ground work for a comprehensive validation study on panic in children. This pilot study is designed to collect preliminary data in four areas and to use the data and experience gained for future grant applications. The four areas where work is necessary and where we will begin to collect pilot data are: 1) thorough assessment of symptoms, medical history, risk factors, psychiatric history, social functioning; 2) detailed family psychiatric history of the children's first degree relatives; 3) assessment of associated biological factors of panic disorder studied in adults such as cardiac auscultation, echocardiogram, lactate infusion and C02 inhalation; 4) a longitudinal follow-up to document clinical course. 'ne feasibility of our methods will be assessed and approaches to promising new leads will be incorporated into later projects. Children with symptoms suggestive of panic attacks will be fully assessed using a structured diagnostic interview and diagnostic instruments as well as echocardiography where possible to obtain data on phenomenology, course, suicidal behavior, comorbidity, family history, medical history, biological markers and social functioning. Information will be obtained from child and from parent about child. Children with disabling panic symptoms meeting DSM-IIIR criteria for panic disorder will be treated with standard treatment interventions including behavioral, cognitive and pharmacological therapies. This sample of child and adolescent onset panic attacks or disorder will become a cohort for future follow-up studies so that we can plot the course, recovery, recurrence biological markers and familial aggregation of the illness. Such data beginning with a cohort of children in non-psychiatric settings is not currently available. Specific aims of this study are to: identify and intensively study a sample of children and adolescents (n=60) ages 6-18 years with panic attacks or panic disorder meeting DSM-IIIR criteria, specifically to describe symptoms, risk factors, psychiatric history and family history; identify and collect family history data on the child's first degree relatives from mother or father; initiate biological marker studies, specifically auscultation and echocardiogram; sample maintenance.